Definition of preleukemia has evolved. It was first used to describe the myelodysplastic syndrome (MDS) with a propensity to progress to acute myeloid leukemia (AML). Individuals with germline mutations of either RUNX1, CEBPA, or GATA2 can also be called as preleukemic because they have a markedly increased incidence of evolution into AML. Also, alkylating chemotherapy or radiation can cause MDS/preleukemia, which nearly always progress to AML. More recently, investigators noted that AML patients who achieved complete morphological remission after chemotherapy often have clonal hematopoiesis predominantly marked by either DNMT3A, TET2 or IDH1/2 mutations, which were also present at diagnosis of AML. This preleukemic clone represents involvement of an early hematopoietic stem cells, which is resistant to standard therapy. The same clonal hematopoietic mutations have been identified in older ‘normal' individuals who have a modest increased risk of developing frank AML. These individuals have occasionally been said, probably inappropriately, to have a preleukemia clone. Our evolving understanding of the term preleukemia has occurred by advancing technology including studies of X chromosome inactivation, cytogenetics and more recently deep nucleotide sequencing.
Objectives Soymilk or tofu production results in considerable okara (soybean pulp) generation. Although okara has a high protein content and contains all essential amino acids, its low water solubility and anti-nutrient presence reduces its protein digestibility. Okara fermented with Rhizopus oligosporus can increase its digestibility by lowering anti-nutrient content and liberating free amino acids. However, neither okara nor biovalorized okara has been evaluated for its effect on postprandial blood amino acids. This study hence explored this gap in knowledge with okara- and biovalorized okara- containing biscuits consumption. Methods The randomized controlled crossover trial involved 15 middle-aged and older Singaporean adults. Each participant undertook 3 separate 2-hour meal tolerance test with 100 g of control biscuits (C), biovalorized okara biscuits (RO), and autoclaved okara biscuits (AOK). RO and AOK were developed with the same recipe as C, utilizing a 20% wheat flour substitution with R. oligosporus fermented okara or autoclaved okara respectively. Biscuit total and free amino acids contents were analyzed by cation-exchange chromatography. Circulating free amino acids concentrations were assessed at timepoints 0, 15, 30, 45, 60, 90, and 120 min. Incremental area under curve (iAUC) and peak concentration were assessed, with results presented as mean (95% confidence interval). Results Biscuit total amino acid content (mean ± standard deviation, g/100 g) was significantly greater for RO (7.51 ± 0.22) and AOK (6.78 ± 0.39) compared to C (5.93 ± 0.33), with RO having notably greater alanine, cysteine, and proline content over AOK. Free amino acid content in biscuit (nmol/g) in ascending order was C (485 ± 11), AOK (698 ± 13), and RO (3414 ± 97). Amino acid iAUC had no significant difference, as demonstrated with total amino acids iAUC (μmol/L·min) (P = 0.568, C: 23 649 (13 738, 33 560), RO: 23 284 (13 374, 33 195) & AOK: 17 257 (7 346, 27 168)). Peak iAUC concentration also showed no significant difference across all amino acids, with total amino acids peak iAUC concentration (μmol/L) as P = 0.560, C: 387 (233,540), RO: 456 (303,610) & AOK: 343 (189,497). Conclusions Consumption of okara- or biovalorized okara- containing biscuits does not alter postprandial amino acid responses in middle-aged and older Singaporeans. Funding Sources Singapore Ministry of Education.
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